Healthcare Provider Details

I. General information

NPI: 1366131328
Provider Name (Legal Business Name): EXPRESS YOURSELF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 STORM KING AVE SW
OCEAN SHORES WA
98569-9638
US

IV. Provider business mailing address

1421 STORM KING AVE SW
OCEAN SHORES WA
98569-9638
US

V. Phone/Fax

Practice location:
  • Phone: 360-751-7131
  • Fax:
Mailing address:
  • Phone: 360-751-7131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: DENISE RENEE ASLIN
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 360-751-7131